Healthcare Provider Details

I. General information

NPI: 1932593506
Provider Name (Legal Business Name): RAMA VINAYAGASUNDARAM SUBRAMANIAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RAMA VINAYAGASUNDARAM M.D.

II. Dates (important events)

Enumeration Date: 03/23/2015
Last Update Date: 11/15/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

865 3RD AVE STE 101
CHULA VISTA CA
91911-1349
US

IV. Provider business mailing address

865 3RD AVE STE 101
CHULA VISTA CA
91911-1349
US

V. Phone/Fax

Practice location:
  • Phone: 619-426-7910
  • Fax: 619-426-2337
Mailing address:
  • Phone: 619-426-7910
  • Fax: 619-426-2337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD461897
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: